Chronic Pancreatitis

General

Clinical Manifestations
Treatment Principle
Herb Formulas
Points

Shao Yang - Yang Ming

Clinical Manifestations	Acute epigastric pain Alternating chills and fever Abdominal pain Constipation or Burning diarrhea Nausea Vomiting Hypochondriac pain Pounding temporal headaches Dizziness Chills Low-grade fever Cold hands and feet Intolerance of Cold Pain in the armpits Unilateral pain in the abdomen and hypochondrium Stiffness and spasms beside and below the umbilicus Pain in the waist and legs T: Normal C: Greasy and white or Greasy and yellow P: Deep, tight and wiry or Wiry and rapid
Treatment Principle	Harmonize and Disperse the Shao Yang Drain Internal Heat Retention
Herb Formulas	Da Chai Hu Tang Da Huang Fu Zi Tang Chinese Patent Medicines: Qing Fei Yi Huo Pian
Points	Ahshi points along the Stomach channel between ST-36 and ST-39, GB-39, LI-4, PC-7, PC-8, REN-12, SJ-5, ST-21, ST-25, ST-34, ST-36, ST-44 With Yin Deficiency: + UB-21 , UB-23 With vomiting or spitting Blood: + PC-4 With fever: + LI-11 Ear: Stomach, Duodenum, Abdomen, Shenmen, Sympathetic

Wei Stage: Summerheat With Damp

Clinical Manifestations	Acute epigastric pain Fever and chills, fever more pronounced or Tidal fever Fever unrelieved by sweating Abdominal distention Thirst Sweating Stifling sensation in the chest Restlessness Irritability Heaviness of the head and body Muscle aches Nausea Vomiting Severe diarrhea Scanty urine T: Red tip and edges C: Greasy yellow P: Floating, rapid and soft
Treatment Principle	Disperse Wind Clear Heat Resolve Damp
Herb Formulas	Xin Jia Xiang Ru Yin
Points	Ahshi points along the Stomach channel between ST-36 and ST-39, LI-4, PC-7, PC-8, REN-12, ST-21, ST-34, ST-36, ST-44 With Yin Deficiency: + UB-21 , UB-23 With vomiting or spitting Blood: + PC-4 With fever: + LI-11 Bleed UB-40, needle DU-14, DU-23, DU-24, GB-20, LI-4, LI-11, REN-9, SJ-5, SP-6, SP-9, ST-8, ST-28, Taiyang, UB-12, UB-20 Ear: Stomach, Duodenum, Abdomen, Shenmen, Sympathetic

Deficiency Of Fluid In The Large Intestine

Clinical Manifestations	Dry stools Knotted constipation or bowel movements once a day Difficulty passing stools Dizziness Bad breath Mouth and throat dry T: Red C: Little P: Thready and rapid
Treatment Principle	Lubricate the Intestines Relieve constipation
Herb Formulas	Zeng Ye Tang
Points	KI-1, KI-3, KI-6, SJ-6, SP-15, ST-25, ST-37, UB-25

Cold-Damp Injuring The Spleen

Clinical Manifestations	Distention and fullness of epigastrium and abdomen Nausea Vomiting Anorexia Loose stools Diarrhea Reduced sensation of taste No thirst or preference for hot drinks Sticky sensation in mouth Borborygmus Lassitude Yin jaundice Heavy head Maybe edema Maybe copious white vaginal discharge Maybe cold limbs, fear of Cold or feeling chilled T: Pink C: Thick, white and greasy or sticky P: Deep and slow
Treatment Principle	Warm Cold Transform Dampness Harmonize the Stomach Strengthen the Spleen
Herb Formulas	Hou Po Wen Zhong Tang Yan Nian Ban Xia Tang
Points	Moxa or moxa needle REN-6, REN-12, SP-6, SP-9, ST-36, UB-20 Cold-Damp Dysentery: Moxa or moxa needle LI-4, REN-6, REN-12, SP-6, ST-25, ST-37 Cold-Damp Diarrhea: Moxa or moxa needle REN-6, REN-12, ST-25, ST-36, ST-37, UB-25 Cold-Damp Vaginal Discharge: Moxa or moxa needle GB-26, REN-4, REN-6, SP-6, ST-36, UB-30 Cold-Damp Jaundice (Yin Jaundice): Moxa or moxa needle DU-9, GB-24, LIV-13, SP-9, ST-36, UB-19, UB-20 , UB-48

Spleen Yang Deficiency

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold
Herb Formulas	Fu Zi Li Zhong Wan With Wind-Cold: Wu Tou Gui Zhi Tang Chinese Patent Medicines: Li Zhong Wan With severe Cold: Fu Zi Li Zhong Wan With Spleen and Stomach Qi Deficiency and Phlegm-Damp: Xiang Sha Liu Jun Zi Tang With Food Stagnation: Zi Sheng Wan
Points	Moxa LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

Spleen Deficiency With Damp Stagnation

Clinical Manifestations	Distention and fullness in chest, epigastrium and abdomen Loss of taste and appetite Heavy sensation and possible weakness in the limbs and body Possible weakness in the limbs Loose stools or diarrhea after eating Easily fatigued Increased desire to sleep Nausea Vomiting Belching Maybe dizziness Feeling lazy with a preference for inactivity Lethargy Acid regurgitation Cough with sputum Borborygmus Shortness of breath Distention and oppression after eating Persistent bitter taste in mouth T: Pale and swollen C: Thick, white and greasy P: Slippery and even or Slow or Moderate or Soft and moderate
Treatment Principle	Tonify the Spleen Dry Dampness Move Qi Harmonize the Stomach
Herb Formulas	Ping Wei San modified With Qi and Blood Deficiency: Gui Pi Tang modified
Points	PC-6, REN-6, REN-10, REN-12, REN-21, ST-25, ST-36 For Cold symptoms: + moxa needle REN-6, REN-12, ST-25, ST-36 For Liver and Spleen Disharmony: - REN-6, REN-12, + ST-21

Spleen And Stomach Qi Deficiency

Clinical Manifestations	Reduced appetite Difficulty digesting Abdominal and epigastric bloating Watery diarrhea Loose stools T: Normal C: Slightly yellow, greasy P: Deficient and frail
Treatment Principle	Strengthen the Spleen Harmonize the Stomach Reduce Food Stagnation Stop diarrhea
Herb Formulas	With Food Stagnation: Jian Pi Wan With Damp-Heat in the Lower Jiao: Sheng Yang Yi Wei Tang
Points

Spleen And Stomach Deficiency Cold

Clinical Manifestations	Mild constant epigastric pain; relieved by warmth and pressure Anorexia Poor appetite Abdominal pain and fullness after meals Nausea Borborygmus Intolerance of Cold Vomiting of thin, watery Fluids Loose, unformed stools maybe with undigested food or Diarrhea Excessive salivation Cold limbs Lassitude Fatigue Heaviness and lethargy, which is worse after meals Weakness Sallow or pale, dull complexion Maybe edema , especially in the fingers, eyelids and abdomen Maybe scanty urination Maybe clear, watery, copious vaginal discharge Emaciation Cold body Weight loss T: Pale and swollen with teethmarks C: White and greasy P: Deep, thready and forceless, Moderate and weal or Deep and slow
Treatment Principle	Strengthen the Spleen and Stomach Warm Yang Warm the Center Stop pain Transform Phlegm-Damp
Herb Formulas	Si Jun Zi Tang modified Huang Qi Jian Zhong Tang With severe Cold: Da Jian Zhong Tang (short-term) With a complex of Heat, Cold and Deficiency: Ban Xia Xie Xin Tang Chinese Patent Medicines: Li Zhong Wan With severe Cold: Fu Zi Li Zhong Wan With Food Stagnation: Zi Sheng Wan
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-6, ST-36, UB-20, UB-21 Moxa or moxa needle LI-11, LU-9, REN-122, REN-13, SP-6, ST-36, UB-20, UB-21 With obvious bleeding or occult blood in the stool: + moxa SP-1 With loose stools or diarrhea: + Zhixie With Fluid Retention and edema: + REN-9, SP-9 With heaviness: + SP-3, ST-40 With nausea: + PC-6 With Phlegm-Damp: + SP-3, PC-5 Ear: Stomach, Spleen, Abdomen, Large Intestine, Small Intestine, Shenmen, Sympathetic

Spleen And Kidney Qi Deficiency

Clinical Manifestations	Milky, turbid spermatorrhea Listlessness Fatigue A shiny, white complexion Anorexia or Increased food intake Restlessness Vaginal discharge Diarrhea Dryness of the external ears Dizziness Enuresis Copious urination Thirst Premature ejaculation Lumbago T: Pale C: White P: Deep and frail
Treatment Principle	Tonify the Kidneys Stabilize Jing Stop leakage Strengthen the Spleen Drain Dampness
Herb Formulas	Fu Tu Dan
Points

Spleen And Kidney Yang Deficiency

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Ba Wei Di Huang Wan + Si Shen Wan
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

Stomach Fire

Clinical Manifestations	Burning Heat and pain in the epigastrium The pain is worse with pressure and or spicy hot foods Irritating thirst: drinks copious fluids and prefers cold drinks Epigastric distention Excessive appetite: hungry again quickly after eating (as if food vanishes) Thirst with a desire for cold drinks Swelling, pain, ulceration and bleeding of gums Foul breath Toothache Maybe vomiting right after eating Vomiting acid or undigested food Heartburn Constipation or maybe diarrhea Restlessness Irritability Maybe scanty, red urine T: Red C: Thick, yellow and dry or Peeled or A wide, shallow crack P: Slippery, big, Excess and rapid
Treatment Principle	Clear and Purge Stomach Fire
Herb Formulas	Qing Wei San modified With Damp-Heat: Huang Lian Jie Du Tang With Yin Deficiency: Yu Nu Jian Chinese Patent Medicines: With mouth ulcers: Niu Huang Jie Du Pian With constipation: Niu Huang Qing Huo Wan
Points	Ahshi points along the Stomach channel between ST-36 and ST-39, LI-4, PC-7, PC-8, REN-12, ST-21, ST-34, ST-36, ST-44 With Yin Deficiency: + UB-21 , UB-23 With vomiting or spitting Blood: + PC-4 With fever: + LI-11 LI-4, LI-11, PC-6, PC-8, ST-6, ST-34, ST-36, ST-43, ST-44, ST-45, UB-21 Ear: Stomach, Duodenum, Abdomen, Shenmen, Sympathetic

Blood Stagnation In The Stomach

Clinical Manifestations	Sharp, stabbing epigastric pain with fixed location Pain is severe after eating Dislike of pressure and heat on epigastrium Pain predominates over distention or Pain but no distention Epigastric rumbling Vomiting purple/black blood Stools with blood like tar (melaena) May be abdominal or epigastric lumps or masses T: Dark purple with purple spots or dots P: Wiry and choppy
Treatment Principle	Invigorate the Blood Adjust Qi Transform Stagnation Stop pain
Herb Formulas	Dan Shen Yin modified Shi Xiao San
Points	SP-4, SP-6, SP-10, ST-21, ST-34, UB-17 PC-6, SP-4, SP-6, ST-36, UB-17

Food Stagnation In The Stomach

Clinical Manifestations	Epigastric fullness, distention and pain with dislike of pressure Belching with rotten food smell Foul breath Acid regurgitation Detests food or Vomits after eating Distention is reduced after vomiting Unformed stools or Knotted constipation or Rotten smelling diarrhea Decreased pain after defecation T: Pink C: Thick and greasy P: Slippery or Wiry and slippery
Treatment Principle	Clear Food Conduct Stagnation
Herb Formulas	Bao He Wan modified
Points	PC-6, REN-10, REN-12, REN-21, ST-21, ST-25 For Cold symptoms: + moxa needle REN-6, REN-12, ST-25, ST-36 For Liver and Spleen Disharmony: - REN-12, REN-13 + REN-21 LIV-13, LIV-14, PC-6, REN-11, REN-12, SP-4, ST-21, ST-36, ST-44 Epigastric pain due to Food Stagnation in the Stomach: 1. LIV-13, PC-6, REN-12, ST-36, ST-44 2. LIV-13, ST-21, ST-44 3. PC-6, REN-11, ST-36 4. PC-6, REN-10, REN-12, SP-4, ST-21, ST-36 Vomiting due to Food Stagnation in the Stomach: PC-6, REN-12, SP-4, ST-25, ST-36

Liver Qi Stagnation

Clinical Manifestations	Distention and pain in the sides or flanks Insidious pain that comes and goes The pain may radiate to the chest, shoulder, upper back and arm Suffocating sensation in the chest Belching Maybe dry heaves Anorexia Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry or Thready and wiry or Deep and thready
Treatment Principle	Soothe the Liver Clear Stagnation
Herb Formulas	Chai Hu Shu Gan Tang modified For Liver Qi Stagnation which has transformed into Heat with Food Stagnation: Qing Yi Tang modified
Points	LIV-13, LIV-14, PC-6, SJ-6 For Heat: - PC-6 + GB-34, LIV-2 For nausea and vomiting: + REN-12 For marked Spleen Deficiency: + ST-36 With Blood Stagnation: + SP-6, UB-17 With Food Stagnation: + ST-21 With constipation: + KI-6 With Stomach and abdominal fullness: + REN-12 GB-40, GB-41, LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, PC-6, SJ-6, SP-6, UB-18

Liver Qi Stagnation Invades The Spleen

Clinical Manifestations	Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Chai Hu Gui Zhi Tang Shao Yao Gan Cao Tang With costal or abdominal pain and menstrual complaints: Si Ni San
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

Damp-Heat In The Liver And Gall Bladder

Clinical Manifestations	Chronic pancreatitis with acute attacks accompanied by chest oppression Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium A dry mouth with a bitter taste Nausea Vomiting sour and bitter fluids Anorexia Aversion to fatty, oily foods Maybe alternating chills and fever A yellowish body and eyes Concentrated, dark urine Abdominal distention and pain Bound stools or Diarrhea which is yellow or brown and foul smelling Maybe jaundice Women: Yellow vaginal discharge with foul smell Pruritis vulvae Men: Pain, swelling and burning sensations of testicles T: Pink C: Yellow and greasy or sticky P: Wiry and rapid or Slippery and rapid or Wiry, slippery and rapid
Treatment Principle	Clear Dampness Purge Heat from Liver and Gall Bladder
Herb Formulas	Da Chai Hu Tang Long Dan Xie Gan Tang Chinese Patent Medicines: Ji Gu Gan Cao Wan Ji Gu Cao Chong Ji Li Dan Pian Long Dan Xie Gan Wan
Points	GB-34, LIV-13, LIV-14, SJ-6, SP-9 With jaundice: + DU-9, UB-18 With Blood Stagnation: + SP-6, UB-17 For Qi Stagnation Transforming into Heat: + LIV-2 With nausea and vomiting: + REN-12 With Spleen Deficiency: + ST-36 With Food Stagnation: + ST-21 With constipation: + KI-6, ST-25 With Stomach and abdominal fullness: + REN-12 GB-24, GB-34, GB-43, LIV-3, LIV-14, SJ-6, UB-18, UB-19 With severe fever: + DU-14, LI-11 With alternating chills and fever: + GB-39, SJ-5 With nausea: + PC-6 With jaundice: + DU-9 Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48

Gall Bladder Damp-Heat

Clinical Manifestations	Alternating chills and fever with fever more prominent A bitter taste in the mouth Nausea Dry heaves Hiccups A stifling sensation in the chest Chest and hypochondriac pain and distention Distending pain in the upper abdomen Vomiting bitter or sour fluids that are yellow and sticky Acid regurgitation Thirst T: Red C: Yellowish or White and greasy or Yellow and greasy P: Left: Wiry and rapid, Right: Slippery and rapid
Treatment Principle	Clear Gall Bladder Heat Dispel Dampness Harmonize the Stomach Resolve Phlegm
Herb Formulas	Hao Qin Qing Dan Tang
Points

Qi And Blood Stagnation

Clinical Manifestations	Lancinating ductal and costal pain or Fixed pain and distention which is worse at night Emaciation Scaly skin A dark, lusterless facial complexion Brittle, ridged fingernails Abdominal lumps and hardness, especially below the ribs Menstrual irregularities T: Dark purple or Static macules or spots and/or engorged, tortuous sublingual veins C: White P: Wiry and choppy
Treatment Principle	Regulate Qi Activate the Blood Break up Stasis Soften hardness
Herb Formulas	Ge Xia Zhu Yu Tang Xue Fu Zhu Yu Tang For pain in the Liver channel: Shu Gan Tang
Points	LIV-13, LIV-14, PC-6, SJ-6, SP-6 With severe Blood Stasis: + LI-4, UB-17 For Qi Stagnation Transforming into Heat:- PC-6 + GB-34, LIV-2 With nausea and vomiting: + REN-12 With Food Stagnation: + ST-21 With constipation: + KI-6, ST-25 With Stomach and abdominal fullness: + REN-12

Qi And Yin Deficiency

Clinical Manifestations	Fatigue Spontaneous sweating Pale wan complexion Poor appetite Loose stools or watery diarrhea Dizziness Weak voice/reluctance to speak Five Sole Heat Malar flush Night sweats Anxiety Hot flashes Weak extremities Weight loss Distention and a stifling sensation in chest and epigastrium Abdominal distention Indigestion Vomiting Chills Leukorrhea Reduced appetite Borborygmus Edema Reduced appetite Diarrhea with onset of menstrual flow Cough with copious sputum T: Pale, Pale red or Red C: Thin white, Little or None P: Deep and weak or Thready and rapid
Treatment Principle	Replenish Qi and Yin Resolve Dampness Generate Body Fluids
Herb Formulas	Shen Ling Bai Zhu Sanmodified Zeng Ye Cheng Qi Tang With Fire Rising: Chronic Pancreatitis #1
Points

Phlegm-Damp

Clinical Manifestations	Epigastric pain that is worse in the morning and with pressure Poor appetite or Anorexia Heaviness of the body Edema Severe abdominal distention Chest and hypochondriac distention Dizziness Foggy-headedness Morning nausea Vomiting of mucus-like substance Acid reflux Vertigo Thirst with no desire to drink Maybe no thirst Palpitations Shortness of breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Phlegm-Damp
Herb Formulas	Er Chen Tang Ping Wei San With Heat: Wen Dan Tang Chinese Patent Medicines: With Spleen and Stomach Qi Deficiency and Phlegm-Damp: Xiang Sha Liu Jun Zi Tang With Food Stagnation: Zi Sheng Wan
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

Phlegm-Heat

Clinical Manifestations	Prolonged, nagging epigastric pain and distention Patient tends to be overweight Cough with sticky, yellow, difficult to expectorate sputum Rapid breathing with a harsh voice Restless fever Sore throat Constipation Thirst with no desire to drink Dry stools Alternating constipation and diarrhea Variable appetite Mania Shortness of breath Dyspnea Nausea Vomiting Chest and/or epigastric fullness A heavy sensation in the body Lethargy Pain in the ribs T: Scarlet C: Yellow or Yellow and greasy or Yellow and smooth P: Rapid and smooth or Slippery and rapid
Treatment Principle	Clear Heat Resolve Phlegm Soothe the Liver Harmonize the Stomach
Herb Formulas	Xiao Xian Xiong Tang  modified Chinese Patent Medicines: Qing Qi Hua Tan Wan Wen Dan Wan
Points	Ahshi points along the Stomach channel between ST-36 and ST-39, LI-4, PC-7, PC-8, REN-12, ST-21, ST-34, ST-36, ST-40, ST-44 With Yin Deficiency: + UB-21 , UB-23 With vomiting or spitting Blood: + PC-4 With fever: + LI-11 LI-11, LU-5, ST-40, UB-13 Ear: Stomach, Duodenum, Abdomen, Shenmen, Sympathetic

Middle Jiao Yang Deficiency With Cold Retention

Clinical Manifestations	Excruciating epigastric and abdominal pain to the point of not being able to to be touched May be borborygmus. Vomiting to the point of not being able to eat Superficial skin pulsations throughout the abdomen May be fluid sounds May be cold limbs Strong sensation of Cold in the chest and epigastrium. Severe pain in the head and feet T: Pale or Dark purple C: White and greasy or Slippery P: Thin and tight or slow and wiry or Deep and thready or Hidden
Treatment Principle	Warm and tonify Middle Jiao Yang Direct rebellious Qi downward Relieve pain
Herb Formulas	Da Jian Zhong Tang
Points